Visit-to-Visit Blood Pressure Variability in Rural Males With Arterial Hypertension: The Possibilities of Modifying in Real Clinical Settings

Abstract

Purpose: to establish the possibilities of modifying blood pressure visit-to-visit variability (VVV) in rural males with arterial hypertension (HTN) by the use of antihypertensive therapy (AHT), considering also the correction of dyslipidemia and certain lifestyle aspects, as well as the changes in compliance with pharmacotherapy (CP).
 Material and methods. The prospective study enrolled 160 rural males with uncomplicated primary HTN (mean age 50 ± 6 years). Seventy three (45,6 %) patients were overweight; 85 (53,1 %) patients were active smokers. An alcohol consumption ≥1 time per week was pointed out by 77 (48,1 %) males. VVV (of systolic (SBP) and diastolic blood pressure (DBP)) was assessed by means of standard deviation (SD) and coefficient of variation (CV). We prescribed a fixed perindopril/amlodipine (P/A) combination, with indapamide (IND) addition as required. With the aim dyslipidemia correction, we prescribed atorvastatin (daily doses 10-40 mg). Optimal CP was pointed out by 37 (23,1 %) patients.
 Results. At 1yFU, all enrolled patients achieved SBP/DBP targets (<140/90 mm Hg), and strict SBP/DBP targets (<130/80 мм Hg) were achieved in 159 (99,4 %) cases. More than 90 % of patients achieved the following prespecified «target» BP VVV levels: SD (SBP) <4,8 mm Hg; CV (SBP) <3,9 %; SD (DBP) <3,7 mm Hg; CV (DBP) <5,1 %. Aimed to predict SD (SBP) reduce >9,7 mm Hg probability at 1yFU, we built the 6-factors logistic regression model: 1) improvement and maintenance of optimal CP (by MGLS) (β = 1,27; р<0,001); 2) body mass index reduce >1,3 kg/m2 (β = 0,57; p=0,035); 3) alcohol consumption modifying (0,72; p=0,007); 4) optimal compliance with atorvastatin daily doses 30-40 mg (1,25; p<0,001); 5) smoking status modifying (0,43; р=0,097); 6) SBP reduce >46,7 mm Hg (0,47; р=0,098). The probability of status «reduction of SD (SBP) >9,7 mm Hg at 1yFU» increase was associated with the higher sum of predictors` β-coefficients.
 Conclusions. In rural HTN males, at 1yFU, the AHT (based on P/A, with IND addition as required) favored the significant blood pressure VVV reduction in the vast majority of cases. The SBP VVV reduction was determined to be additively affected by the modifying of certain factors, as well as by achievement and maintenance of maximum CP.